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New Health of America Report Shows Retail Clinic Visits are Up Despite a Lag Among Individually Insured

Jan. 18, 2017

While many Americans are taking advantage of retail clinics, it seems not all consumers are accessing this convenient, lower-cost health care option at the same rate. Blue Cross Blue Shield Association's (BCBSA) newly released Health of America (HoA) Report found the upward trend in retail clinic visits was fueled by consumers who obtained health insurance through an employer. By contrast, usage by new individually insured members has lagged since the Affordable Care Act (ACA) marketplaces started offering coverage in 2014. For instance, Blue Cross and Blue Shield of Texas (BCBSTX) saw visits increase 13 percent from 2014 to 2015 among employer group members, while visits fell 13.5 percent among members who were individually insured.

There are more than 2,000 retail clinics located in pharmacies, grocers and “big box” stores that provide care for simple, acute conditions — such as bronchitis and flu — and administers services such as vaccinations or certain tests. Typically staffed by nurse practitioners, they offer convenient evening and weekend hours as well as walk-in appointments.

Another key finding from the HoA report is that as many as 29.8 percent of emergency room (ER) visits were for conditions that could easily have been treated in a retail clinic, further evidence that more work is needed to help consumers understand the importance of utilizing the appropriate care setting. Prices for retail clinic visits are significantly lower than a visit to the ER and slightly less expensive than a doctor’s office visit.  

Blue Cross and Blue Shield of Texas (BCBSTX) is continuously improving programs and services, collaborating doctors, hospitals and other stakeholders to ensure members have convenient access to cost-effective and quality care in the most appropriate setting. One clear example is the Virtual Visits program, powered by MDLIVE, which allows members on-demand access to board-certified physicians anywhere they need it, including phone, video conference or mobile app. This service offers the unique opportunity to provide timely access to quality care for members who are unable to visit a doctor office, or those who live in rural communities and may face barriers to care near their homes.

In addition, BCBSTX offers a 24/7 nurse line where members can connect live with a nurse to share their symptoms and get advice on where to go for treatment or whether over-the-counter options may be effective.

Members can find additional resources for Choosing Health Care Options on BCBSTX.com including information on appropriate care settings for dozens of common health conditions, along with the average cost per visit and wait times.

This latest HoA report is the tenth from the collaboration between BCBSA and Blue Health Intelligence, which uses a market-leading claims database to uncover key trends and insights into health care affordability and access to care. The report was written by and includes medical claims data from HealthCore Inc., a wholly-owned and independently operated health outcomes subsidiary of Anthem, Inc. For more information and to see the full report, visit www.bcbs.com/healthofamerica.